Provider Demographics
NPI:1508072703
Name:METRO TREATMENT OF UTAH LP
Entity Type:Organization
Organization Name:METRO TREATMENT OF UTAH LP
Other - Org Name:LOGAN METRO TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-351-7080
Mailing Address - Street 1:14050 TOWN LOOP BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6190
Mailing Address - Country:US
Mailing Address - Phone:407-351-7080
Mailing Address - Fax:407-351-6930
Practice Address - Street 1:1300 N 200 E
Practice Address - Street 2:SUITE 104
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2398
Practice Address - Country:US
Practice Address - Phone:435-755-5915
Practice Address - Fax:435-775-5917
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO TREATMENT OF UTAH LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-15
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11675251S00000X
UT5888583-17043336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No3336C0002XSuppliersPharmacyClinic Pharmacy